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Radiation and Ethylene Oxide Terminal Sterilization Experiences with Drug Eluting Stent Products

  • Review Article
  • Theme: Sterile Products: Advances and Challenges in Formulation, Manufacturing, Devices and Regulatory Aspects
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Abstract

Radiation and ethylene oxide terminal sterilization are the two most frequently used processes in the medical device industry to render product within the final sterile barrier package free from viable microorganisms. They are efficacious, safe, and efficient approaches to the manufacture of sterile product. Terminal sterilization is routinely applied to a wide variety of commodity healthcare products (drapes, gowns, etc.) and implantable medical devices (bare metal stents, heart valves, vessel closure devices, etc.) along with products used during implantation procedures (catheters, guidewires, etc.). Terminal sterilization is also routinely used for processing combination products where devices, drugs, and/or biologics are combined on a single product. High patient safety, robust standards, routine process controls, and low-cost manufacturing are appealing aspects of terminal sterilization. As the field of combination products continues to expand and evolve, opportunity exists to expand the application of terminal sterilization to new combination products. Material compatibility challenges must be overcome to realize these opportunities. This article introduces the reader to terminal sterilization concepts, technologies, and the related standards that span different industries (pharmaceutical, medical device, biopharmaceuticals, etc.) and provides guidance on the application of these technologies. Guidance and examples of the application of terminal sterilization are discussed using experiences with drug eluting stents and bioresorbable vascular restoration devices. The examples provide insight into selecting the sterilization method, developing the process around it, and finally qualifying/validating the product in preparation for regulatory approval and commercialization. Future activities, including new sterilization technologies, are briefly discussed.

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References

  1. United States Code of Federal Regulations, Title 21, Volume 1, Part 3, Section 3.2 (e), Definitions.

  2. PharmaLive.com. Special reports: drug-delivery review and outlook. 2010.

  3. Conroy S. The industry’s Trifecta: drugs, devices and biologics. MD&DI; 2009. www.devicelink.com/mddi. Accessed 31 Jan 2011.

  4. Kereiakes DL et al. Comparison of everolimus-eluting and paclitaxel-eluting coronary stents in patients undergoing multilesion and multivessel intervention. JACC Cardiovasc Interv. 2010;3(12):1229–39.

    Article  PubMed  Google Scholar 

  5. Caixeta A et al. Clinical follow-up 3 years after everolimus- and paclitaxel-eluting stents. JACC Cardiovasc Interv. 2010;3(12):1220–8.

    Article  PubMed  Google Scholar 

  6. Serruys PW, Waksman R, Onuma Y, editors. Vascular restoration therapy, EuroIntervention supplement. 2009;5 Suppl F. Supplement is entitled and dedicated to the theme of vascular restoration therapy and initial devices.

  7. Serruys PW et al. A bioabsorbable everolimus-eluting coronary stent system (ABSORB): 2-year outcomes and results from multiple imaging methods. Lancet. 2009;373:897–910.

    Article  PubMed  CAS  Google Scholar 

  8. MedMarket Diligence report #C245, worldwide market for drug-eluting, bare and other coronary stents. 2009;2008–2017.

  9. Lambert BJ. Sterilisation: material compatibility challenges and guidance for combination products. European Medical Device Technology. 2010;21–25.

  10. ISO/TS 11139:2006. Sterilization of health care products—vocabulary. 2006.

  11. Favero MS. Sterility assurance: concepts for patient safety, in disinfection, sterilization and antisepsis: principles and practices in healthcare facilities, chapter 12. In: Rutala WA, editor. Association for Professionals in Infection Control and Epidemiology. DC.: Washington; 2001. p. 110–9.

    Google Scholar 

  12. Lolas AG. US FDA, Center for Drug Evaluation and Research, Regulatory Approaches for Novel Processing and Innovative Products, invited presentation at the 15th International Meeting on Radiation Processing. London: September 2008.

  13. ANSI/AAMI ST67:2011. Sterilization of health care products—Requirements and guidance for selecting a sterility assurance level (SAL) for products labeled "STERILE". See Annex A, Background and historical application of sterility assurance.

  14. ANSI/AAMI ST67:2011. Sterilization of health care products—Requirements and guidance for selecting a sterility assurance level (SAL) for products labeled "STERILE". See Annex B, Examples of terminally sterilized products and sterility assurance levels that have historically been selected.

  15. ISO TC 198. ISO/Draft International Standard, Aseptic processing of health care products, Part 7: Alternate processes for atypical medical devices and combination devices.

  16. AAMI TIR 17:2008. Compatibility of materials subject to sterilization. 2008.

  17. AAMI TIR37:2007. Sterilization of health care products—radiation—guidance on sterilization of human tissue-based products. The need for tissue product sterilization drove the development of this document. 2007

  18. Jarvis WR, Epidemiology Branch. Nosocomial outbreaks: the Centers for Disease Control’s Hospital Infections Program Experience, 1980–1990. In: Martone WJ, Garnder JS, editors. Proceedings of the 3rd decennial international conference on nosocomial infections. Am. J. Med 1991;91 Suppl 3B. p. 101S–106S.

  19. Jarvis WR. Centers for Disease Control and Prevention, Hospital Infections Program on-site outbreaks investigations, 1990–1999: how often are germicides or sterilants the sources. In: Rutala WR, editor. Disinfection, sterilization and antisepsis: principles and practices in healthcare facilities. Washington, DC: Association for Professionals in Infection Control and Epidemiology; 2001.

    Google Scholar 

  20. Higashi JM, Marchant RE. Implant infections. In: Recum AFV, editor. Handbook of biomaterials evaluation: scientific, technical, and clinical testing of implant materials. Philadelphia: Taylor & Francis; 1999. p. 493–506.

    Google Scholar 

  21. RTI, Proven Record of Safety, Sterilization Process. http://www.rtix.com/safety/sterilization-processes. Accessed 30 Jan 2011.

  22. ISO 14937:2009, Sterilization of health care products—general requirements for characterization of a sterilizing agent and the development, validation, and routing control of a sterilization process for medical devices. See introduction. 2009.

  23. ANSI/AAMI ST67:2003. Sterilization of health care products—requirements for products labeled “STERILE”. 2003.

  24. ISO 11137-1 Sterilization of health care products—radiation—part 1: requirements for development, validation, and routine control of a sterilization process for medical devices.

  25. Kowalski JB, Morrison RF. Sterilization of implants and devices. In: Ratner BD et al., editors. Biomaterials science: an introduction to materials in medicine. San Diego: Elsevier Academic; 2004. p. 754–9.

    Google Scholar 

  26. ISO 11135-1: 2007. Sterilisation of healthcare products, ethylene oxide, part I: requirements for development, validation and routine control of a sterilisation process for medical devices, Annex B, Conservative determination of lethal rate of the sterilization process—Overkill approach. 2007.

  27. Hemmerich KJ, et al. Sterilization methods stand the test of time. Medical Device and Diagnostic Industry. 2004;26(8). http://www.mddionline.com/article/sterilization-methods-stand-test-time. Accessed 30 Jan 2011.

  28. ISO 11135-1: 2007. Sterilisation of healthcare products, ethylene oxide, part I: requirements for development, validation and routine control of a sterilisation process for medical devices. 2007.

  29. Phillips C. The sterilizing action of gaseous ethylene oxide II. Sterilization of contaminated objects with ethylene. AM J HTO. 1949;50:280–8.

    CAS  Google Scholar 

  30. Silverman J. Radiation processing: the industrial applications of radiation chemistry. J Chem Ed. 1981;58:168–73.

    Article  Google Scholar 

  31. ANSI/AAMI/ISO 14937:2009. Sterilization of health care products—general requirements for characterization of a sterilizing agent and the development, validation, and routing control of a sterilization process for medical devices. 2009.

  32. Committee for Proprietary Medical Products (CPMP) Decision Trees for the Selection of Sterilisation Methods (CPMP/QWP/054/98). Annex to note for guidance on developmental pharmaceuticals (CPMP/QWP/155/96).

  33. Matthews IP, Gibson C, Samuel AH. Sterilisation of implantable devices. Clin Mater. 1994;15:191–215.

    Article  PubMed  CAS  Google Scholar 

  34. Mendes GCC, Brandão TRS, Silva CLM. Ethylene oxide sterilization of medical devices: a review. Am J Infect Control. 2007;35:574–81.

    Article  PubMed  Google Scholar 

  35. Lindboe WG, Hayakawa K. Comparative terminal sterilization. J Parenter Sci Technol. 1993;47(3):138–41. This article addresses moist heat sterilization of pharmaceuticals.

    PubMed  CAS  Google Scholar 

  36. Serruys PW, Ong ATL, Piek JJ, et al. A randomised comparison of a durable polymer everolimus-eluting coronary stent with a bare metal coronary stent: the SPIRIT first trial. EuroIntervention. 2005. p. 58–65.

  37. Oberhauser J, Hossainy S, Rapoza R. Design principles and performance of bioresorbable polymeric vascular scaffolds. EuroInterv Suppl. 2009;5(Suppl F):F15–22.

    Google Scholar 

  38. The XIENCE V® everolimus eluting coronary stent system instructions for use, p. 53. 2010. http://www.abbottvascular.com/us/ifu.html. Accessed 30 Jan 2011.

  39. Loo JSC, Ooi CP, Boey FYC. Degradation of poly(lactide-co-glycolide) (PLGA) and poly(l-lactide) (PLLA) by electron beam radiation. Biomaterials. 2005;26(12):1359–67.

    Article  PubMed  CAS  Google Scholar 

  40. Güven O. The use of size exclusion chromatography in the studies of crosslinking and chain scission in polymers. In: Güven O, editor. Crosslinking and scission in polymers. Dordrecht: Kluwer Academic; 1990. p. 39–250.

    Google Scholar 

  41. ISO 11137-1:2006. Sterilization of health care products—radiation—part 1: requirements for development, validation and routine control of a sterilization process for medical devices. Clause 8, Process Definition. 2006.

  42. AAMI TIR 33:2005. Sterilization of health care products—radiation—substantiation of a selected sterilization dose—method VDmax. 2005.

  43. AAMI TIR 40:2009. Sterilization of health care products—radiation—guidance on dose setting utilizing a modified method 2. 2009.

  44. Lambert BJ, Tang FW. Rationale for practical medical device accelerated aging programs in AAMI TIR17. Radiat Phys Chem. 2000;57(3–6):349–53.

    Article  CAS  Google Scholar 

  45. ICH Q1A (R2). Stability testing of new drug substances and products. 2003.

  46. J. Kulla J, et al. Sterilising combination products using oxides of nitrogen. Medical Device and Diagnostic Industry. 2009;31(3). www.mddionline.com/article/sterilizingcombination-products-using-oxides-nitrogen. Accessed 30 Jan 2011.

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Correspondence to Byron J. Lambert.

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Guest Editors: Lavinia Lewis, Jim Agalloco, Bill Lambert, Russell Madsen, and Mark Staples

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Lambert, B.J., Mendelson, T.A. & Craven, M.D. Radiation and Ethylene Oxide Terminal Sterilization Experiences with Drug Eluting Stent Products. AAPS PharmSciTech 12, 1116–1126 (2011). https://doi.org/10.1208/s12249-011-9644-8

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